股骨近端防旋髓内钉扩髓与否对老年股骨转子间骨折的疗效影响  

Effect of the reaming and non-reaming proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly

作　　者：孙晓望 梁凡[2] 邓明[2] SUN Xiao-wang;LIANG Fan;DENG Ming(Dept of Orthopaedics,the People′s Hospital of Huangmei County,Huanggang,Hubei 435500,China;Dept of Orthopaedics,the People′s Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]黄梅县人民医院骨科,湖北黄冈435500 [2]武汉大学人民医院骨科,湖北武汉430060

出　　处：《临床骨科杂志》2020年第6期854-857,共4页Journal of Clinical Orthopaedics

基　　金：中央高校基本科研业务费专项资金(编号:2042017kf0139);湖北省自然科学基金面上项目(编号:ZRMS2019000278)。

摘　　要：目的比较股骨近端防旋髓内钉(PFNA)扩髓与否对老年股骨转子间骨折的疗效影响。方法将144例老年股骨转子间骨折患者根据PFNA插入方式不同分为扩髓组(插入PFNA之前行股骨髓腔扩髓,70例)和不扩髓组(插入PFNA之前不行股骨髓腔扩髓,74例)。比较两组手术时间、髓内钉直径、术中出血量、术后血红蛋白下降量、术后输血率、术后输血量、术后住院时间、术后离床活动时间、术后完全负重时间、骨折愈合时间、术后并发症及术后12个月髋关节Harris评分。结果术后切口均一期愈合。两组患者均获得12个月随访。随访期间无感染、内固定失败等情况发生。手术时间、术中出血量、术后血红蛋白下降量、髓内钉直径不扩髓组均优于扩髓组(P<0.05);术后输血量、术后输血率、术后住院时间、术后离床活动时间、术后完全负重时间、骨折愈合时间及术后12个月髋关节Harris评分两组比较差异无统计学意义(P>0.05)。结论鉴于老年患者对手术时间长、手术创伤大、失血量多的耐受性较差,建议采用PFNA治疗老年股骨转子间骨折时不进行扩髓。Objective To compare the efficacy of reaming and non-reaming proximal femoral nail anti-rotation(PFNA)in the treatment of intertrochanteric fractures in the elderly.Methods The 144 elderly patients with intertrochanteric fractures were divided into the reaming group(70 cases with medullary cavity reaming before insertion of PFNA)and the non-reaming group(74 cases with medullary cavity non-reaming before insertion of PFNA),according to the PFNA insertion method.The following data were compared between the two groups,including the operation time,intramedullary nail diameter,intraoperative blood loss,postoperative hemoglobin decrease value,postoperative blood transfusion rate,postoperative blood transfusion volume,and postoperative hospitalization time,postoperative out-of-bed activity time,postoperative full weight-bearing time,fracture healing time,postoperative complications and hip Harris score at 12 months postoperation.Results The postoperative incision was healed in one-stage.All patients were followed up for 12 months.During the follow-up period,the patient had no related complications.The operation time,intraoperative blood loss,hemoglobin decrease value,and intramedullary nail diameter of the reaming group were better than those of the non-reaming group(P<0.05);there were no significant differences in the postoperative blood transfusion volume,postoperative transfusion rate,hospitalization time,healing time,postoperative out-of-bed activity time,postoperative full weight-bearing time,and hip Harris score at 12 months postoperation(P>0.05).Conclusions Considering that the elderly patients have poor tolerance for long operation time,long surgical incisions,and more blood loss,it is suggested that non-reaming PFNA be used for the treatment of elderly intertrochanteric fractures.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 扩髓 不扩髓 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]